State officials are moving to come up with ways to address the issue, which researchers found may have caused as many as 174 Medicaid beneficiaries to overdose over 12 months. The overdoses probably are higher because the researchers could track only those that resulted in an emergency-room visit and could not identify overdoses in which no hospitalization occurred.

In response, state Medicaid may put in place dosing and quantity limits and ban the prescribing of more than two long-acting opioid painkillers at one time, said Judy Zerzan, the chief medical director for the Colorado Department of Health Care Policy and Financing. A handful of other states have put in place similar restrictions, including Maine, which limits Medicaid patients to two weeks of painkillers a year, allowing renewal in two-week intervals under special circum-stances.

Colorado also will hire consultants to educate and train primary-care doctors on best pain-management protocols, similar to a program in New Mexico. Colorado also has begun alerting Medicaid doctors and patients when high-risk prescribing patterns are detected.

“People need to realize that while there are those benefits in terms of pain control, there are potential harms, and people need to think about those and people need to know where to go for help if they have problems with addiction,” Zerzan said.

Changes to a state registry, meant to prevent abuse of such drugs, also are in the works. Under legislation Gov. John Hickenlooper signed into law last week, prescribers are authorized to designate additional associates to use the Colorado Prescription Drug Monitoring Program.

That program requires all prescribing and dispensing of certain controlled substances to be entered into computers. Prescribers and pharmacists are encouraged to use the program to cross-check individual patient use or buying patterns. The state also plans to start proactively reviewing that registry to detect dangerous prescribing patterns. When dangerous-use patterns are detected, the state will alert prescribers.

The reports, prepared for Colorado Medicaid, found that 15 doctors are responsible for most of the prescribing of painkillers.

Those doctors were the only ones that made 1,000 or more painkiller prescriptions in the state’s Medicaid program from July 1, 2012, through June 30. The top prescriber made 4,657 such prescriptions.

The study, done by researchers at the Skaggs School of Pharmacy and Pharmaceutical Sciences at the University of Colorado Anschutz Medical Campus, did not identify the doctors or draw any conclusions about the efficacy of their level of prescribing. Officials declined to provide the names.

The analysis followed the creation of a state task force by Hickenlooper to reduce prescription-drug abuse in Colorado, a state that federal officials have identified as having the second-highest rate of nonmedical use of painkillers in the nation in those over the age of 12.

From 2000 to 2012 the number of painkiller-overdose deaths in Colorado more than tripled, up to nearly 300, according to Peer Assistance Services Inc., a nonprofit that works with the state, and the Colorado Department of Public Health and Environment. Denver police further report that such painkillers increasingly are becoming for youths a gateway drug that leads to heroin use.

The University of Colorado review found that just 2.1 percent of the 71,481 Medicaid beneficiaries in the state who were prescribed a painkiller during the year analyzed took them for cancer issues. Nearly 19 percent took the painkillers for chronic bodily pains. About 29 percent of the patients had no identified condition in their electronic Medicaid files that the state maintains.

Colorado’s drug-utilization review board, which sets policies for drug use in the state’s Medicaid program, reviewed the reports in February. Based on that review, the board authorized Colorado’s Department of Health Care Policy and Financing to concentrate on the most hard-core patients who have the three high-risk traits in their use of painkillers.

“We agreed to flag individuals and identify them for additional case management rather than cut them off abruptly,” said Dr. Robert Page II, a CU professor who presented the findings to the board. “Then we will run numbers and see how it plays out.”

Dr. Gina Moore, another CU professor who did the study, said halting the medication immediately for those individuals could cause dangerous withdrawals that could prompt strokes, seizures and even deaths.

“If these people are potentially abusing medications on state dollars, no one wants that to continue indefinitely, but in a first step, we want to get them to case management as opposed to cutting them off cold turkey,” Moore said.

The board probably will authorize further restrictions in the future and expand the case management to more patients, Moore and Page said.

“This is really a starting point to recognize the people at the greatest risk,” Moore said.

The board decided that Medicaid patients who exhibit all three of the following painkiller-use traits will be identified for interventions and counsel:

• They have received a painkiller prescription — such as OxyContin — that has a daily dose equivalent to at least 300 milligrams of morphine.

• They are getting their painkillers from four or more different pharmacies.

• They have received a prescription for a painkiller supply lasting at least 300 days.

The researchers found that nearly 15,000 Medicaid patients in Colorado had one or more of those traits in the year analyzed, which put them at a risk of overdose from nine to 14 times higher, depending on the trait exhibited. At least one of those traits showed up in 174 Medicaid patients who overdosed in that year.

The study found that 556 beneficiaries, 15 of whom overdosed, had all three traits.

Christopher N. Osher can be contacted at cosher@denverpost.com or 303-954-1747 or @chrisosher. Chris is a reporter on the investigation team at The Denver Post who has covered law enforcement, judicial and regulatory issues for the newspaper. He also has reported from war zones in Africa.

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